Bill C-14 (Historical)

An Act to amend the Criminal Code and to make related amendments to other Acts (medical assistance in dying)

This enactment amends the Criminal Code to, among other things,
(a) create exemptions from the offences of culpable homicide, of aiding suicide and of administering a noxious thing, in order to permit medical practitioners and nurse practitioners to provide medical assistance in dying and to permit pharmacists and other persons to assist in the process;
(b) specify the eligibility criteria and the safeguards that must be respected before medical assistance in dying may be provided to a person;
(c) require that medical practitioners and nurse practitioners who receive requests for, and pharmacists who dispense substances in connection with the provision of, medical assist­ance in dying provide information for the purpose of permitting the monitoring of medical assistance in dying, and authorize the Minister of Health to make regulations respecting that information; and
(d) create new offences for failing to comply with the safeguards, for forging or destroying documents related to medical assistance in dying, for failing to provide the required information and for contravening the regulations.
This enactment also makes related amendments to other Acts to ensure that recourse to medical assistance in dying does not result in the loss of a pension under the Pension Act or benefits under the Canadian Forces Members and Veterans Re-establishment and Compensation Act. It amends the Corrections and Conditional Release Act to ensure that no investigation need be conducted under section 19 of that Act in the case of an inmate who receives medical assistance in dying.
This enactment provides for one or more independent reviews relating to requests by mature minors for medical assistance in dying, to advance requests and to requests where mental illness is the sole underlying medical condition.
Lastly, this enactment provides for a parliamentary review of its provisions and of the state of palliative care in Canada to commence at the start of the fifth year following the day on which it receives royal assent.

Criminal Code

[Cheryl Gallant, Conservative, Renfrew—Nipissing—Pembroke, ON]

Madam Speaker, as a matter of fact, a worker in palliative care explained to me that Canadians are very confused by the bill because the definition of palliative care is medical assistance in dying. This bill is the same thing. They are begging the question, does the government think that palliative care and assisted dying as in the bill are one and same.

Janet from Cobden said it best: “Real medicine does not kill. Real medicine alleviates suffering without eliminating the one who suffers.” She asks if I am “okay with corrupting real medicine to allow for this abuse to occur? The court made a fundamental error in making this decision.”

[Ziad Aboultaif, Conservative, Edmonton Manning, AB]

Madam Speaker, the question I have heard twice today from the opposite side is this. Is it better to have a law today than not having a law? Are we telling people we are going to pass the bill for assisted dying today because it is cheaper than assisted dying tomorrow? Why can we not ask for extra time and make sure that we get the best bill possible? I would like to see if my hon. colleague would be able to comment on this.

[Cheryl Gallant, Conservative, Renfrew—Nipissing—Pembroke, ON]

Madam Speaker, through the correspondence I received, many people, as they were from Ontario, are skeptical that the whole bill has little more to do with saving the provincial government money in health care costs.

[Larry Miller, Conservative, Bruce—Grey—Owen Sound, ON]

Madam Speaker, it is a pleasure to speak to the bill today in the House of Commons and share my time with the hon. member for Renfrew—Nipissing—Pembroke.

I am pleased to rise in the House today to speak to the legislation, as I said. I have had the honour of being a member of Parliament since 2004. I can honestly say that this is one of the most sensitive and controversial pieces of legislation that I have spoken to in the House. This is an issue that many Canadians have very strong opinions on, so it is very important that throughout this process we respect all sides and ensure that we can come up with the best legislation possible, which responds to as many concerns as possible.

Today I would like to share some of my personal opinions on the legislation, as well as the expressed opinions of my constituents, many whom I have heard from. My vote on the bill will be based on what my constituents want and what my own conscience is telling me.

I recently wrote an op-ed in my local newspapers and distributed it to all media in the riding to connect with and consult with my constituents on the bill. I asked them to send their concerns to my office so that when I vote on the bill, I can be confident that I am voting in a manner that represents the views of my constituents. As of right now, the majority of my constituents, almost 80%, have told me to vote against the legislation. I want to point out that some of them are totally opposed to the bill and some would support some small amendments but are against it in its current form.

Emails and letters are still coming in as we speak. The main concerns that have been presented by those who disagree with the bill are the need for further protections for the vulnerable, further protections for the conscience rights of health care workers, and the need for an improved national palliative care strategy.

I share many of the same concerns as my constituents. It is absolutely vital that there are safeguards for those who are vulnerable. For me, this includes three different groups of people. The first group would be children. We need to have a more robust discussion and study whether children under 18 years old should be allowed access to physician-assisted dying and who has the authority to make that decision.

Second, it is paramount that those who have debilitating diseases, such as Alzheimer's, have a number of safeguards to ensure that they have fully consented to physician-assisted death while they were in a sound state of mind. The bill, as it is currently drafted, has a number of important first steps, but I feel it could go much further. The question is simple. Are there enough safeguards? Are we certain that we have it right?

I appreciate the work that was done by the special committee that was struck to hold consultations before drafting the bill and also the work done by the justice committee. This has been a very one-sided and rushed process. When it comes to protecting the vulnerable, I do not want to leave any stone unturned. A matter like this deserves an intense and lengthy study by parliamentarians, all parliamentarians. It is very disturbing to know that at this point the government is not willing to have that full debate.

Furthermore, it was made very clear in the House last night that the government is not willing to even entertain the notion of adopting any amendments, and that is wrong. On such a sensitive matter, it would have been my hope that the government would take a more sincere approach to working with other parties in an attempt to get the bill right.

A number of important amendments that would have addressed some very serious concerns were voted down by the government last night. I was deeply disappointed to see partisanship take precedence over common sense. It was refreshing to see some individuals, in all parties, vote according to their consciences and beliefs. That does not happen enough in this place, so I thank those members.

Finally is the question of whether the bill would allow those with mental illnesses to have access to physician-assisted death, as expressed by some of my colleagues. I would be very troubled if this was the case. It is my firm belief that mental illness is, in fact, an illness.

That being said, I would find it very troubling if an individual who was suffering from a mental illness had access to physician-assisted death. Mental illness quite possibly could mean that someone in a very poor state of mind, to use that terminology, could ask for assisted suicide when he or she would in all likelihood maybe not make this choice if in a sound state of mind. I believe this would send a wrong message to others suffering from mental illness. I am afraid that it would encourage more suicide, assisted or otherwise.

There are many groups in my riding who have put in a tremendous amount of work to combat mental illness and educate those suffering with mental illness that help is always available. We need to send that message that help is always available. Being able to seek physician-assisted death for a mental illness would, in my mind, run counter to this work. This is another area that deserves much closer study so that we as members of Parliament can be confident that the bill would not allow this.

Furthermore, National Nursing Week was only a few weeks ago. In light of this, it is very important to reiterate that we need robust protections for the conscience rights of health care professionals. Last night, the government had an opportunity to recognize the conscience rights of health care professionals, but chose not to take it. An amendment proposed by my colleague, the member for Sherwood Park—Fort Saskatchewan would have recognized that medical practitioners and health care professionals are free to refuse to provide direct or indirect medical assistance in dying. Unfortunately the government voted against this amendment.

The Charter of Rights and Freedoms states, “Everyone has the following fundamental freedoms”. What is first on that list? It is freedom of conscience and religion. I urge the government to put partisanship aside and recognize the charter rights of health care professionals. No one should be forced to perform any task that goes against his or her freedom of conscience or beliefs.

I am not trying to reopen a previous debate held in the House, but I have to use an example that is very similar to the point that I am trying to make right now. Therefore, I would compare this to ministers or clergy who do not believe in performing same-sex marriages. Freedom of conscience and religion are fundamental freedoms that protect individuals who do not wish to take part in something that runs counter to their beliefs. This same kind of thing is not in the bill. Simply put, someone should not be required to participate in something or provide any service that she or he does not believe in. This must be an important consideration in designing the regulatory framework. Again, I wish that we had more time to hear from concerned health care professionals about this.

I would like to conclude with a comment on the timeline of this issue, and voice my concerns around putting forward legislation in such a rushed manner.

As I said earlier, I have been a member of Parliament since 2004, and in that 12 years that I have spent in this place, this bill is near or at the top of the list of the most intense and deeply sensitive matters I have spoken to.

I fully recognize, as we all do in the House, the limitations on the orders that come from the Supreme Court. However, having said that, rushing through the bill and getting it not right is not worth the sake of a few days or weeks, whatever it takes. I urge all members to think about that. June 6 is a date that everybody has hard ingrained in their minds, but I am quite sure the courts would allow flexibility.

Let us take the time and do it right. Given the sensitivity and public concern with this issue, I do not think that it is appropriate or prudent to rush through this process. I fully understand that there is a stated deadline, as I said, that the court has given Parliament to have it done. However, with this in mind, once again I have to point out that I have a number of concerns with the Supreme Court's limiting the ability of members of Parliament to have the time to have a robust debate and to allow for a more intense study of this important issue.

On too many instances I have heard some members say they will just have to revisit this in the future or they will revisit that part of it, as if they are admitting that this is a flawed bill, and it is a flawed bill. As members of Parliament I do not think that we can—

[The Assistant Deputy Speaker, Carol Hughes]

Excuse me, I am sorry. The time is up.

Questions and comments, the hon. member for Fleetwood—Port Kells.

[Ken Hardie, Liberal, Fleetwood—Port Kells, BC]

Madam Speaker, I thank the two previous speakers because between them they laid out the essence of the challenge facing the House in coming to a reasonable decision on this.

It is very difficult to get something as complex as this right the first time, and I can appreciate why the previous government basically backed away from this kind of process, because it did have the better part of the year to deal with the consequences of the Supreme Court decision.

Particularly regarding the preamble, I would like to ask a question of the hon. member. It says:

Whereas everyone has freedom of conscience and religion under section 2 of the Canadian Charter of Rights and Freedoms; Whereas nothing in this Act affects the guarantee of freedom of conscience and religion;

Furthermore, this morning I had the opportunity to ask the Minister of Health whether or not that extended to the freedom not to refer somebody ahead. What additionally would the member prescribe that would provide the kind of comfort that he seems to ask for in terms of medical practitioners?

[Larry Miller, Conservative, Bruce—Grey—Owen Sound, ON]

Madam Speaker, I think it is very clear and obvious that the government, the minister, is trying to pretend that safeguards for health care professionals, doctors, etc., are there and they are protected. It is clear to most Canadians, including a lot who voted for the government, that the safeguards are not in place.

I find it ironic that a few weeks or months ago we were all saddened to hear about the rash of suicides in Attawapiskat, and all of a sudden we switch gears and we are into a bill that is basically suicide in another form.

[Cathy McLeod, Conservative, Kamloops—Thompson—Cariboo, BC]

Madam Speaker, I heard my colleague from Bruce—Grey—Owen Sound talk with great passion about the issue of mental health.

He also talked about the amendments that had been proposed. A very logical amendment to me was that someone perhaps with cancer who had an underlying mental health issue would have a psychiatric assessment as part of their decision-making. I was really surprised that something that seemed so important and logical as having a psychiatric assessment was turned down in the House. I am just wondering if my colleague would make some comments on that particular issue.

[Larry Miller, Conservative, Bruce—Grey—Owen Sound, ON]

Madam Speaker, my colleague and friend raises a very good point.

Another safeguard in the bill, which I spoke to in my speech, is to make sure that when people make the decision, if it comes to that in their life where they want to have assisted suicide, their decision is made in a strong state of mind.

The condition that could have put that in place in the bill was an amendment that went before the House last night and was turned down by the government. Why? It just looks like partisanship. The Liberals figure they got it right the first time and they will not listen to anyone when they say the opposite. It showed last night that they are not willing to listen to any advice on the bill and that is very disappointing.

[Jane Philpott, Liberal, Minister of Health]

Madam Speaker, I am going to be splitting my time with the member for Surrey Centre.

The topic we are addressing today is a solemn one. As a result, the past few weeks have been emotional for all parliamentarians, myself included, as we have wrestled with the matter of assisted dying.

The government had the responsibility to respond to the Supreme Court decision that was made in February 2015. I joined my colleagues in addressing that responsibility after we formed government in November 2015. Thus, in the very short time since forming government, there has been an incredible amount of work by officials and parliamentarians, with input from Canadians with a diverse range of views.

Before us today is a legislative framework that we believe is the right approach for Canada. It is transformative. It would forever change the range of options that Canadians would have as they approach the end of their life. I would like to reflect on the principles that make up the foundation of our government's legislative approach in developing the legislation that is before the House today.

First, it is about the principle of personal autonomy, in helping people to write their own story, in a sense, in providing Canadians with access to medical assistance in dying, for the Supreme Court made it clear to us that Canadians must have that access.

We have the responsibility to abide by the Charter of Rights and Freedoms, and we have the responsibility to put forth legislation that respects the decisions of the Supreme Court of Canada. This legislation before the House today, if passed, would do just that.

The legislation also respects the principle of the inherent value of life. It is written, therefore, with appropriate safeguards that would protect vulnerable individuals. It would also firmly uphold the conscience rights of health care providers.

Over the past several weeks and months, I have had conversations with members in this chamber from all sides of the House. The Minister of Justice and I have appeared at committees in the House and the Senate. I have personally had numerous meetings and phone calls with many interested advocates, in addition to the witnesses whom committees have heard on this particular legislation.

It is worth noting today that the professional bodies that represent health care providers are supportive of this legislative approach. These include the Canadian Medical Association, Canadian Nurses Association, Canadian Pharmacists Association, and HealthCareCan, which represents our nation's hospitals and academic health sciences centres.

Just today, parliamentarians received an open letter from 36 organizations representing the vulnerable, including the Canadian Association for Community Living, which has come out in support of this bill. Each organization may have continued areas of interest in which they wish to seek clarifications or undertake work with my department or with provinces and territories so that they can properly work with their members on implementing assistance in dying.

As I have said in the past, this is an iterative process. It is why not only would we study further potential areas of assisted dying within a short period of time, if the legislation passes, but there would also be a parliamentary review of this important legislation.

Let us discuss the matter of timing. The Supreme Court of Canada gave our government an extension to put a legislative framework in place by June 6. Before going further, allow me to say that I respect the roles and responsibilities everyone has here as parliamentarians, as well as the responsibilities that senators hold in the upper chamber.

There is a good reason for all of us to want to reflect upon and investigate this legislation in a thoughtful manner on behalf of Canadians. The reality is that we are facing a finite amount of time before there is a legal void, an absence of legislation to address the matter.

Despite what some may say, there are real and very serious challenges if there is no legislative framework in place. As I said yesterday, there is a real risk that there could be no law in place by June 6. It is important to underscore what is at stake.

First, organizations like the Canadian Medical Association and the Canadian Medical Protective Association have made it clear that they believe there is a vast majority of doctors who would not participate in assistance in dying without a legislative framework, despite the protections that some say the Carter decision provides.

Doctors are being advised by the appropriate associations to seek legal counsel before proceeding with any form of assisted dying, including consulting patients, and this would pose significant access issues and result in a situation where the Supreme Court's decision is not being realized.

Second, it would be illegal for any other health care providers to offer assistance in dying. That means that nurses, pharmacists, social workers, and other providers recognized by amendments passed at committee would face no legal protection. In particular, pharmacists who are needed to dispense medications required for medical assistance in dying require clarification.

Finally, there is the possibility that some could receive assistance in dying without a legislative framework in place, who would not otherwise have been eligible under the government's approach. This means, for example, the risk that someone facing severe depression could seek assistance in dying and that the safeguards to protect that individual would be inadequate or nonexistent.

I also want to remind members that medical assistance in dying is unlikely to be the choice for the vast majority of individuals at the end of life, and at its core our health care system is there to keep Canadians healthy. Canadians should have access to high-quality palliative care. This is something to which I have been, and will continue to be, committed to addressing with our provincial and territorial colleagues, along with the delivery of our government's platform commitment of $3 billion for home care.

Our government put forth this legislation that would transform end-of-life care options for Canadians. It is an approach that respects their rights under the charter, protects our most vulnerable, and considers the needs of health care providers.

I want to thank my fellow parliamentarians for their attention to the bill. Many of us are new to this role, and this is no small matter that we have been asked to address on behalf of the 36 million Canadians whom we represent. I thank them for engaging in the conversation with respect and dignity. I thank them for doing their utmost to consider the perspective of others, even if it differs greatly from their own. I thank them for the serious discourse we have undertaken in a situation where it is likely impossible to write legislation that would entirely satisfy every diverse view.

Recognizing our responsibility to implement legislation, I urge members to support Bill C-14 for today's final vote. I look forward to working with the Senate, if the House wishes to proceed to the next stage of our legislative process.

[Cathy McLeod, Conservative, Kamloops—Thompson—Cariboo, BC]

Madam Speaker, I would like to acknowledge the very difficult job the Minister of Health has had in crafting this piece of legislation.

The one piece of the bill that I find very bothersome is the $3 billion commitment to palliative care. I know the Liberals argue that they have to work out a deal with the provinces in health accords.

There are many items in the budget, and I could pull out five or six where commitments have been made in the budget and all the t's and i's have not been crossed and dotted. Why was the money for palliative care not in the budget this year? Does the minister not believe that the government could work something out with the provinces and territories in a timely way on such an important issue?

[Jane Philpott, Liberal, Markham—Stouffville, ON]

Madam Speaker, one of the themes we have heard many times in the House is the importance of Canadians having access to high-quality palliative care.

As my colleague knows, health care delivery lies largely in the domain of provinces and territories. I have been impressed with the work of my colleagues, the ministers of health in those jurisdictions, and I will continue to work with them. We look forward to establishing a health accord that will provide further investments to enhance the work they are already doing in the area of palliative care.

[Brigitte Sansoucy, NDP, Saint-Hyacinthe—Bagot, QC]

Madam Speaker, when we asked Department of Justice and Department of Health officials to identify the legal or legislative basis for the reasonably foreseeable natural death clause, they referred us to the minister. I am not yet convinced that this clause, which nobody really seems to understand, is necessary.

Can the minister tell us why such a vague clause was included in such an important bill?

[Jane Philpott, Liberal, Markham—Stouffville, ON]

Madam Speaker, the member's question is one we have heard before, and I am pleased to answer it today.

As the member knows, we were asked to establish legislation on the matter of medical assistance in dying. The Carter decision included language around grievous and irremediable conditions. In drafting the legislation, it was felt that there had to be further clarification, which has been supported by health care workers who, in one sense, did not want to be limited by a particular deadline to say it is expected that a person is within six months of dying.

This is a piece of language that has been supported to respect the professional opinion of health care providers who know when a grievous and irremediable condition has reached the point that death is reasonably foreseeable.

[Sean Casey, Liberal, Parliamentary Secretary to the Minister of Justice and Attorney General of Canada]

Madam Speaker, I have two quick questions.

If we do not have legislation in place by June 6, or if there is a gap, what happens to the process that is presently available for patients to apply to a court to be granted medical assistance in dying?

Second, if we do not have a bill in place by June 6, or if there is a gap thereafter, will medical assistance in dying be available to people who do not have a health card and who are not covered by medicare?